​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ Western Health Endoscopic Services provides a comprehensive range of diagnostic and therapeutic endoscopy procedures for inpatients and outpatients.

Direct Access to Gastrointestinal Endoscopic Procedures (D.A.G.E) Pathway

Western Health has developed a pathway to assist GPs to refer patients who meet the criteria for an urgent (Category 1 - i.e. within one month) Gastrointestinal Endoscopy. This pathway was previously known as the RAGE (Rapid Access to GI Endoscopy) Pathway, but has been modified to be consistent with the new gastroscopy and colonoscopy categorisation guidelines.

Two Pathways have been developed. 

• DAGE pathway for patients with overt gastrointestinal bleeding.pdf 

• DAGE pathway for patients without gastrointestinal bleeding.pdf

A Symptom Guide has also been developed to complement the pathways. This outlines the most important signs or symptoms associated with colorectal cancer and oesophageal or gastric cancer. DAGE Symptom Guide.pdf.

When referral for DAGE is made, it is important that the referring doctor provides the patient with the opportunity to discuss reasons for colonoscopy, its benefits, risks and alternative options before deciding to proceed. After discussion with the referring doctor if the patient has further questions that have not been answered the patient should contact the Endoscopy Liaison Nurse (ELN) on 8346-6015 to seek further advice.

If after speaking with the Western Health Endoscopy Liaison Nurse the patient is still not satisfied with information provided, the patient cannot proceed via the DAGE pathway. The patient will be referred to attend Gastroenterology clinic or Standard Endoscopy clinic for consultation to discuss suitability for the procedure and address patient concerns.

Please note this may introduce a significant wait time due to high demand for outpatient clinic appointments.

Please see below links from the Gastroenterological Society Australia regarding patient education materials around Colonoscopy, Gastroscopy, and Bowel Preparation:
Colonoscopy: https://www.gesa.org.au/resources/patients/colonoscopy/

Bowel preparation: http://cart.gesa.org.au/membes/files/Consumer%20Information/Bowel%20prep.pdf

Gastroscopy: http://cart.gesa.org.au/membes/files/Consumer%20Information/Gastroscopy_A4.pdf 

Please provide these pamphlets to your patients at the time of making a DAGE referral.

Referral Templates

The D.A.G.E form is available in versions that can be uploaded into practice software

PDF Version
COR 179b Gastrointestinal Endoscopy Referral form (2 page).pdf 

Medical Director 

WH Endoscopy GP Referral Form Dec18- MD.rtf   *IMPORTANT DO NOT OPEN UNTIL READING INSTRUCTIONS BELOW*

Medical Director Import Instructions
1. DO NOT OPEN IN WORD
2. Right click on the link and then select Save As… (Or Save Target As…) and then save the file to a location from where you can later retrieve it i.e.​ desktop or My documents.
3. Open Medical Director and then LetterWriter
4. File menu > Select modify template > Select blank template
5. File > Select import - locate downloaded file

Best Practice 
WH Endoscopy GP Referral Form Dec18 - BP.rtf  *IMPORTANT DO NOT OPEN UNTIL READING INSTRUCTIONS BELOW*

Best Practice Import Instructions
1. DO NOT OPEN IN WORD
2. Right click on the link and then select Save As… (Or Save Target As…) and then save the file to a location from where you can later retrieve it i.e. desktop or My documents. ​Open a new letter and from templates menu select Import templates
3. Locate downloaded file and open
4. From File menu select Save as. Type in an appropriate template​ name and click on save

ZedMed
Zedmed​ Import Instructions

ZedMed RTF  *IMPORTANT DO NOT OPEN UNTIL READING INSTRUCTIONS BELOW*

1. DO NOT OPEN IN WORD
2. Right click on the link and then select Save As… (Or Save Target As…) and then save the file to a location from where you can later retrieve it i.e. desktop or My documents. ​
3. Click on Tools > Clinical WP Setup > WP Templates
4. File > Import Template​
5. Find the file where you saved it and highlight it and then click Open​
6. Enter the template name into the Description field. Click on OK​ 

Referral Decisions and Acceptance Considerations

The colonoscopy guidelines make use of the NHMRC colonoscopy surverillance guidelines.

For the purposes of colonoscopy referrals, the Victorian DHHS has summarised these guidelines as follows:

Clinical Practice Guidelines for Surveillance Colonoscopy. This guideline should be used in conjunction with the endoscopy referral form when requesting colonoscopies for surveillance of colorectal cancer or colorectal polyps.

After completing the endoscopy referral form, please also attach the relevant supporting documents such as blood tests, radiology imaging results, previous endoscopy and histology reports. This information is critical to enabling us to triage the referral correctly. Without the necessary supporting information as requested on the referral form, it is likely that the referral will be rejected with a request for more information.

The endoscopy referral form and supporting documents should be faxed to the WH Endoscopic Services Booking office on fax number (03) 8345-7378.​

• ​Urgent referrals for bronchoscopy or EBUS should be referred to the on call Respiratory Registrar by phoning the Western Health switchboard on 8345 6666 and asking the staff to page the Respiratory Registrar.

• Urgent referrals for advanced GI endoscopy procedures such as ERCP, EUS, EMR, complex polypectomy or luminal stenting, especially for patients who are currently inpatients at WH or at other hospitals, should be made to the Gastroenterology Advanced Endoscopy Fellow by phoning the Western Health switchboard on 8345 6666 and asking the staff to page the Endoscopy Fellow.

An important message to referring doctors: The time to procedures is affected by the referral demand we experience for procedures. At times, the volume of referrals is very high, and can result in delays to procedures.

Please note: If you are concerned about the delay for your patient, of if there is a deterioration in the patient's condition that may alter their triage category, please contact the Endoscopy Liaison nurse. You may then be requested to forward us this additional information for potential re-triaging.